Xanthochromia of the skull bone associated with HbA1c.

The color of the surface of 105 skull bones (part of the parietal bone) was determined using a portable spectral colorimeter (spectro color(®)). By this means it was possible to characterize the color objectively according to the L*a*b* color system defined by the "International Commission de l'Eclairage" (CIE). Biochemical markers of carbohydrate metabolism, HbA1c from venous blood, and glucose/lactate concentrations from vitreous humor, were also determined, for assessment of the ante-mortem plasma glucose concentration using Traub's sum formula. As biochemical markers for lipid metabolism disorder, cholesterol, triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL) and very low density lipoprotein (VLDL) were all determined from venous blood. There is a significant correlation of bone yellowing with HbA1c (p<0.001) and age (p<0.001). The literature asserts a significant correlation between diabetic condition and yellowing of the skull bone. Despite efforts to find the substance responsible for the yellowing of the bone in chronic metabolism disorder, no significant correlation was found between bone color and lipoproteins/bone extracted lipid acids.

[Induratio penis plastica and the capability of vaginal penetration in the context of forensic evaluation]. / Induratio Penis Plastica und Vaginale Penetrationsfähigkeit im Kontext der Forensischen Begutachtung.

The so-called Induratio penis plastica (IPP), also known as Peyronie Disease or Morbus Peyronie, is the most common cause for deviation of the male penis. In most cases, the deviation is directed to the dorsal side. In face of a lawsuit related to a sexual offence, the opponent might argue that, due to an existing IPP, he is generally unable to insert his penis into a female's vagina. The aim of the present study was to examine the clinical files of thirty (30) consecutive patients who presented with IPP. Particular attention was given to the individual degree of penile deviation and the ability of the subjects to conduct vaginal intercourse. Subjects who had a dorsal penile deviation of 800 to 900, or a lateral deviation of 600, were unable to commence vaginal coitus. In contrast, three (3) subjects who presented with a ventral deviation of 30° to 40° had no difficulties in performing vaginal penetration. The medicolegal aspects of these findings are being discussed.

Bloodless aortic dissection.

"Bloodless aortic dissection" is a rare cause of sudden death due to an aortic dissection without intimal tears and with no blood present within the dissected aortic wall. The first case was described in 1993. Death was considered to be caused by acute myocardial ischemia from dissection involving the left coronary artery. Further cases have been described where death was thought to originate from increasing hypertension during progressive extension of the dissection followed by a sudden irritation of the subendothelially localized conduction system of the heart. The presented case involves a rapidly fatal aortic dissection in a 64 year old man without any intimal tears and no blood in the dissected aortic wall, although the dissection involved the entire aorta. Death was considered due to myocardial ischemia since the dissection had reached the aortic root and the origins of the coronary arteries.

Serum procalcitonin levels in the postmortem diagnosis of sepsis.

Procalcitonin is regarded as a valuable marker for sepsis in living persons and even in post-mortem investigations. At the Institute of Legal Medicine, 25 autopsy cases with suspected bacterial infectious diseases or sepsis were examined using the semi-quantitative PCT-Q(®)-test (B.R.A.H.M.S., Germany) in 2010 and 2011. As controls, 75 cadavers were used for which there was no suspicion of a bacterial infectious disease or sepsis. Femoral blood was cultured from the cases and from controls, and samples from the brain, heart, lungs, liver, spleen and kidneys were examined histologically for findings seen in sepsis. Twelve cases in the sepsis/infectious disease group (48%) were classifiable as sepsis following synopsis of PCT levels, autopsy results, and histopathological and microbiological findings. This study shows that the semi-quantitative PCT-Q(®)-test is a useful supplementary marker in routine autopsy investigations, capable of classifying death as due to sepsis.

Unattended fatal haemorrhage due to spontaneous peripheral varicose vein rupture--two case reports.

Venous haemorrhage is a rare complication of varicose veins of the legs. Varicosis is found in 15-50% of the population. Haemorrhage from ruptured varicose veins of the legs can occur spontaneously or after a minor trauma. More frequent complications of varicosis include peripheral oedema of the ankles, skin pigmentation and skin ulcers. In case of venous haemorrhage simple possibilities of first aid can be applied, therefore fatal haemorrhage is a rarity. Two cases of fatal varicose vein rupture are presented. A 58-year-old man and a 76-year-old woman, both living alone, were found dead in the bathrooms of their apartments. Significant traces of blood were found in all rooms. Both corpses showed typical signs of death from exsanguination. No traumatic lesion was found. Cause of the haemorrhage was a small lesion of the skin of the lower legs of the victims with continuation to an underlying superficial varicose vein. Misinterpretation of life-threatening varicose haemorrhage, unconsciousnous, alcohol or drug influence, old age and dementia can promote the death. In case of fatal haemorrhage the death scene can simulate crime due to massive traces of blood and may focus primarily on a non-natural death. However, police investigations and autopsy will disclose the rare cause of spontaneous natural death.

Postmortem diagnostics of assumed food anaphylaxis in an unexpected death.

Diagnosis of lethal anaphylaxis is known to be difficult to establish in forensic autopsy. Cases of anaphylactic shock have to be dealt with in forensic medicine comparatively frequently as death due to anaphylaxis is likely to occur rapidly and without warning in seemingly healthy subjects. Autopsy findings might hint at allergic reaction, but classic manifestations can also be completely absent. A case of suspected food anaphylaxis in a middle-aged woman is presented. The deceased had been known to suffer from multiple allergies. Death came about after an evening meal with friends. Dyspnoea was reported to have been followed by collapse, unconsciousness and death within minutes. The course of further analysis undertaken (toxicology, biochemistry, immunohistochemistry) is examplarily described. By means of the results presented we discuss problems and possibilities of postmortem diagnostics of food induced anaphylaxis.

Determination of glycyrrhetic acid after consumption of liquorice and application to a fatality.

Besides alcohol and drugs of abuse, several popular foods contain potentially toxic substances and cases of intoxication after consumption of these foods attract notice of forensic toxicology. This is also true for the case of a 34-year-old woman who was suspected to have suffered lethal acute intoxication from eating nothing but liquorice over a period of several months. The liquorice ingredient glycyrrhizin and its metabolite glycyrrhetic acid, which elicits a mineralocorticoid effect, were determined in the sort of liquorice the woman had consumed by using LC-MS/MS. In addition, a fast and sensitive procedure for the quantification of glycyrrhetic acid including a simple sample preparation was developed. The method was proven to be accurate and precise. In a liquorice ingestion experiment, 200 g of liquorice had to be eaten. Afterwards, concentrations of glycyrrhetic acid in the blood of up to 434 ng/ml were measured. Since only traces of glycyrrhetic acid had been found in the blood and stomach content of the deceased woman, the possibility of acute lethal glycyrrhetic acid intoxication could be eliminated. Excluding other causes of death, the woman is believed to have died from a lethal hyperglycemic coma. Nonetheless, the influence of harmful and toxic substances in food should be taken into consideration in special cases.

Extended suicide using an atypical stud gun.

Suicides with stud guns are uncommon, but are well documented in the literature. On rare occasions, stud guns are also used as a homicide weapon. This case report describes an extended suicide in which a husband killed his wife and their two dogs, which lived on the property. The husband then committed suicide with a shot from the stud gun into his skull. He was a 70-year-old pensioner, a retired butcher, who was found by his son. He was lying in a supine position on a carpet in the living room, with the stud gun stuck in his skull. During autopsy, high concentrations of an antihistamine were found in the blood of each corpse; this drug is used as a soporific. In contrast to the literature, which mainly describes powder deposits due to the use of conventional stud guns, in this case a stud gun was used in which the expanding gases and powder escaped together with the central bolt at the front of the device; powder drains were not involved. Detailed findings of the autopsy are given with reference to this type of stud gun.